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Explaining Separation Anxiety

What it is, why it happens, and how it's treated 

Rachel Ehmke

Senior Writer
Child Mind Institute

Toddlers who cling to mom as she's leaving for work or wail when they're handed to the babysitter are fairly common. Though their anguish troubles us, we know most of them will grow out of their fear of separating from parents as they get older and more confident about their own powers.

But for some children the anxiety persists into the school years, and becomes more rather than less pervasive. These kids have developed separation anxiety disorder, and their worries about being apart tend to mushroom far beyond the moment of separation. Mobile phone technology, rather than mitigating anxiety, can actually exacerbate the disorder, since now there is the expectation that we can always be in touch with each other. Many parents of kids with separation anxiety are used to getting dozens of worried text messages and phone calls throughout the day while they are at work or their child is at school, and some kids will start to panic when mom or dad doesn't answer or is out of cell phone reception range.

Separation anxiety itself, when developmentally appropriate, is not necessarily a bad thing. Though it feels uncomfortable, anxiety can be useful because it spurs us to be more thoughtful and cautious when approaching a new situation. Ron Steingard, MD, a psychiatrist at the Child Mind Institute, explains, "At different stages of development it is normal to have problems around separation, because the world is not safe, and you haven't learned how to master being away from the people who take care of you. As you develop, and as you begin to master situations and develop skills, it should get easier."

But for kids who have severe, persistent anxiety at separating, it doesn't get easier. These kids will have an unusually hard time saying goodbye—one mom we know has considered quitting her job because of the panic attacks her daughter has whenever she leaves for work—but the anxiety doesn't stop there. The distress these kids feel about separating prevents them from participating in age appropriate activities and learning opportunities like joining sports teams or even in some cases attending school. The anxiety takes a social toll as well—these are the nine-year-olds who still need mom to stand next to them during a birthday party or won't consider attending a sleepover unless it is being hosted at their own home.

Overattachment also persists at home, where children will often "shadow" one parent from room to room. Some kids with separation anxiety fear being left alone upstairs or sleeping alone in their beds. Parents tell us about kids who insist on sharing mom and dad's bed at night or describe getting woken up "like an alarm clock" every morning at 5 or 6am when their child crawls into bed with them.

While younger children generally become anxious at the moment of separation, older children can experience anticipatory anxiety. Clark Goldstein, PhD, says some of the children he treats for separation anxiety actually get more nervous anticipating a separation than they actually get during the separation itself. These kids might also have nightmares about separating. Whether their distress is anticipatory or immediate, many kids also feel the physical symptoms of anxiety, which include headaches or stomachaches.

If you think of anxiety as an alarm system which functions when we perceive a threat, kids with separation anxiety have faulty alarm systems, notes Dr. Steingard. "They have either an alarm system that's on all the time, so they really never feel comfortable taking risks and moving forward, or they have one of these faulty alarm systems that go off every once in a while and just blow them out of the water. Either way they can get locked onto a strategy of having someone there that can protect them—usually parents. This person can afford me safety, so I'm going to stay with them. Or this place is my safe place; I'm going to stay with it."

If these symptoms sound familiar, and you've noticed them persisting over time, it's a good idea to talk to your child's pediatrician or consult with a specialist. Anxiety is harder to treat the longer the child has lived with it. But the good news is that most kids respond very well to treatment, particularly if it is caught early.

Treatment for separation anxiety disorder typically involves cognitive behavioral therapy, a treatment approach that helps children learn to manage their fears. This might include exposure therapy, a form of treatment that carefully exposes children to separation in small, controlled doses, helping to reduce anxiety over time. Doctors might also employ relaxation training and coping statements that encourage rational, positive thinking to help decrease anxiety. In some more difficult cases medication might be prescribed to help reduce anxiety and make therapy more effective.

Another important component of treating separation anxiety is parent training. Sympathetic parents who want to spare their kids worries may inadvertently be strengthening them.

"Parents are usually very reluctant to separate themselves because they know their child is worrying," explains Dr. Jerry Bubrick, a psychologist who works with kids who have separation anxiety. "But by being reluctant, they're actually reinforcing the fear rather than reinforcing the effort to separate." Parents can help by offering positive reinforcement every time a child successfully completes one of her goals. Some doctors teach parents to give a child points towards a reward for each goal she completes.

Treating separation anxiety allows kids to get back to the business of being kids, which is learning. The longer kids continue living with their anxiety, the more they miss out on important learning opportunities. And the longer they make choices based on avoiding painful separation, the greater the chance that they will develop avoidant personalities and other anxiety or mood disorders.

"Untreated, these kids can become very inhibited individuals who are risk-avoidant," notes Steingard, "which is a bad thing in childhood, because childhood is filled with risk-taking and learning. Kids are at the moment where they're expanding. By necessity, their universe has to expand. Everything that they're exposed to is novel, and exposure to novel events is essentially anxiety-provoking. Most of us learn how to master that anxiety, develop skills that allow us to walk into new situations, meet new people. We need to help these kids catch up in development of mastery and accrual of skills until they're at the point where they're strong enough to stand on their own."

Published: June 26, 2012

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